This project involved the analysis of linked birth and death certificates from Missouri for the years 1980-1984. The 200,000 births occurring during this period are being studied to determine whether or not cesarean sections performed for very low birth weight infants have any advantages over vaginal delivery after adjusting for various complications of delivery. Our preliminary analysis suggests that the vaginal delivery of a very low birth weight infant carries a greater risk of day 1 death than does cesarean section. This was not the case in infants of higher birth weight and the significance of the finding is being explored.